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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005901
Report Date: 01/28/2025
Date Signed: 01/28/2025 03:36:55 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/14/2025 and conducted by Evaluator Jessica Cho
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250114092205
FACILITY NAME:BEACH TERRACE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
306005901
ADMINISTRATOR:DENNIS ROBENIOLFACILITY TYPE:
740
ADDRESS:12282 BEACH BOULEVARDTELEPHONE:
(714) 694-3205
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY:120CENSUS: 45DATE:
01/28/2025
UNANNOUNCEDTIME BEGAN:
07:00 AM
MET WITH:Dennis Robeniol- Executive DirectorTIME COMPLETED:
03:37 PM
ALLEGATION(S):
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Facility plumbing is in disrepair.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of concluding and delivering the findngs into the above allegation. LPA was greeted and granted entry by Medication Technician (MT) Samantha Hernandez and explained the reason for the visit to Executive Director (ED) Dennis Robeniol at 8:45am.

On January 16, 2025, LPA initiated the complaint investigation. During the course of the investigation, LPA interviewed seven staff and five residents and obtained documentation which consists of the Resident/Staff Rosters, Staff Contacts, Personnel Report, Infection Control Plan, Face Sheets, Physician's Reports, Needs and Services Plans of residents, and other pertinent records. LPA toured and observed the areas repaired and housekeeping room with Maintenance Director (MD) Felipe Decon, as well as the common areas and residents' rooms.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/14/2025 and conducted by Evaluator Jessica Cho
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250114092205

FACILITY NAME:BEACH TERRACE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
306005901
ADMINISTRATOR:DENNIS ROBENIOLFACILITY TYPE:
740
ADDRESS:12282 BEACH BOULEVARDTELEPHONE:
(714) 694-3205
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY:120CENSUS: 45DATE:
01/28/2025
UNANNOUNCEDTIME BEGAN:
07:00 AM
MET WITH:Dennis Robeniol- Executive DirectorTIME COMPLETED:
03:37 PM
ALLEGATION(S):
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Facility did not notify residents and families of water shut-off.
Facility did not follow the infection control requirements.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of concluding and delivering the findngs into the above allegations. LPA was greeted and granted entry by Medication Technician (MT) Samantha Hernandez and explained the reason for the visit to Executive Director (ED) Dennis Robeniol at 8:45am.

On January 16, 2025, LPA initiated the complaint investigation. During the course of the investigation, LPA interviewed seven staff and five residents and obtained documentation which consists of the Resident/Staff Rosters, Staff Contacts, Personnel Report, Infection Control Plan, Face Sheets, Physician's Reports, Needs and Services Plans of residents, and other pertinent records. LPA toured and observed the areas repaired and housekeeping closets with Maintenance Director (MD) Felipe Decon, as well as the common areas and residents' rooms.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20250114092205
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: BEACH TERRACE ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 306005901
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/04/2025
Section Cited
CCR
87468.1(a)(8)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: 8) "To have their representatives regularly informed by the licensee of activities related to care or services..."
This requirement was not met as evidenced by:
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Executive Director stated that procedures will be developed and submitted to LPA for future repairs that may potentially affect the care and/or supervision of residents as well as submiting an Acknowledgement of Understanding of the said deficiency via email by POC due date.
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Based on interviews and record review, six out of the seven staff and three out of the five residents confirmed no advance notice was given to residents and their representatives regarding the lack of water during the repair which poses a potential health, safety, or personal rights risk to persons in care.
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Type B
02/04/2025
Section Cited
CCR
87470(a)(1)(A)
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87470 Infection Control Requirements
(a) A licensee shall ensure that infection control practices are maintained as follows: (1) All staff and volunteers shall perform hand hygiene. (A) "Hand hygiene shall include hand washing with soap and water or using an alcohol-based sanitizer or any other sanitizing method..."
This requirement was not met as evidenced by:

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Executive Director stated that they will obtain hand sanitizers to be worn and carried by staff at atll times and will submit an Acknowledgement of Understanding of the said deficiency to LPA via email by POC due date.
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Based on observations and interviews, hand sanitizer dispensers and/or wipes were not available except for selected rooms only accessible for staff and four out of the five residents corroborated not being able to wash or sanitize their hands during the repair which poses a potential health or safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20250114092205
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BEACH TERRACE ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 306005901
VISIT DATE: 01/28/2025
NARRATIVE
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The investigation revealed the following: It is alleged that the facility did not notify residents and families of the water shut off. Per the interviews conducted, three out of the five residents confirmed no notice was given ahead of time regarding the water shut off on repair dates January 14, 2025 and January 15, 2025. Six out of the seven staff also corroborated with the allegation. Based on the review of the emails, ED was informed on January 7, 2025 at 12:06pm for the repair scheduled on the 14th allowing ample time for the residents and their families to be notified by the facility.

Regarding the allegation, facility did not follow the infection control requirements, it is alleged that the facility did not maintain hand sanitizers or wipes for the residents to perform proper hand hygiene during the water shut off. Facility maintained sufficient supply of hand sanitizers in the medication rooms and supply rooms per inspection conducted on the 16th. Also observed in the housekeeping rooms, were barrels of clean water at each level available for cleaning and for resident use. Per observations, hand sanitizers and/or wipes were not observed in the residents' rooms and common areas making it inaccessible for residents and staff to sanitize their hands. Based on the interviews, four out of the five residents corroborated indicated not being able to wash or sanitize their hands with an alcohol based sanitizer and/or wipes while one resident maintained their own hand sanitizer in their room. Six out of the seven staff denied the allegation indicating that proper hand hygiene were practiced such as wearing gloves and using hand sanitizers while assisting residents while the water was shut off. Five out of the seven staff also confirmed providing hand sanitizer to the residents as needed. Based on observations and information obtained, it is determined that the residents were unable to practice proper hand hygiene during the repairs which could have been prevented if hand sanitizer dispenser stations were available and/or carried by the staff to deter theft and ensure easy access.

Therefore, based on LPA's observations, interviews which were conducted, and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegations, Facility did not notify residents and families of water shut off and Facility did not follow the infection control requirements are deemed SUBSTANTIATED. Deficiencies are being cited on the attached LIC9099-D.

An exit interview was conducted with Executive Director Dennis Robeniol, and a copy of this report including the LIC9099-D, and the appeal rights were provided at exit.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20250114092205
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BEACH TERRACE ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 306005901
VISIT DATE: 01/28/2025
NARRATIVE
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The investigation revealed the following: It is alleged that the facility plumbing is in disrepair. The water tested in the bathrooms were observed operable on January 16, 2025. During the tour conducted with MD Decon on January 16th, LPA observed three carpet stains caused by a water leak originating from the pipes running through the ceiling on the second floor. MD stated that the second floor leak is correlated to the leak from the boiler room. Upon inspection, LPA observed mineral buildup and rust on the isolation valves on the connecting pipes of the water boiler tanks which is caused by water corrosion and hard water per MD. MD stated that the the facility is running on a temporary boiler during the repair while the fittings on the pipes are being replaced and the boiler repaired. Based on the interviews conducted, five out of the five residents and seven out of the seven staff confirmed the water not working for several hours. Only one out of the five residents confirmed the water was turned off on these exact dates, January 14-15, 2025, which also corroborated by four out of the seven staff. Based on the review of the emails and job summary, no repair was scheduled and conducted on January 13th therefore the water was not turned off. The work order history documents facility was serviced on January 14th from 6am to 2pm per the job summary. MD indicated an additional day of repair was continued the following day. Email correspondences dated January 2, 2025 at 11:01am and 3:26pm reveal facility attempting to expedite the repair with the boiler company however could not be expedited due to "part availability and correct technicians/mechanics for each job."

Based on the information obtained, repairs are required as a result of normal wear and tear. The pipes were in disrepair causing the water to be shut off during the repair. While facility tried to resolve the issues within a timely manner, the delay was due to scheduling conflicts with the boiler company, not the facility.

Therefore, based on the observations made, interviews which were conducted, and the records that were reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the following allegation, Facility plumbing is in disrepair, is deemed UNSUBSTANTIATED.

An exit interview was conducted with Executive Director Dennis Robeniol, and a copy of this report was provided at exit.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5